Type III Tympanoplasty With Titanium Total Ossicular Replacement Prosthesis: Anatomic and Functional Results

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

OBJECTIVE

To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology.

METHODS

A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out.

RESULTS

Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls.

CONCLUSION

Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success.

LEVEL OF EVIDENCE

3B.

Extrusion and Dislocation in Titanium Middle Ear Prostheses: A Literature Review

Titanium middle ear (ME) prostheses are widely used in surgical practice due to their acoustic properties. However, they present a significant drawback shared by all synthetic materials currently in use for ME reconstruction: they can be rejected by the organism of the host. In this study, we aim to review the current literature on titanium partial ossicular replacement prostheses (PORPs) and total ossicular replacement prostheses (TORPs) extrusion and dislocation. Eighty articles were analysed after a full article review based on the inclusion and exclusion criteria. The most common indication for reconstruction was chronic otitis media with cholesteatoma. The average extrusion or dislocation rate was 5.2%, ranging from 0 to 35%. The average improvements in the air-bone gap were 12.1 dB (1.6 dB to 25.1 dB) and 13.8 (-0.5 dB to 22.7 dB) for the PORP and TORP groups, respectively. The data reported on this topic are highly variable, demonstrating that functional outcomes are difficult to predict in clinical practice. We believe that the current limitations could be overcome with technological developments, including bioengineering research focused on promoting prosthesis adaptation to the ME environment.

A retrospective study of audiological outcomes after endoscopic tympanoplasty and tympanomastoidectomy in patients with cholesteatoma

OBJECTIVES

To investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients.

METHODS

This was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures.

RESULTS

Eighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P < 0.05) at every frequency, except for BC-LF (P > 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P < 0.05). Additionally, shifts in AC, BC, and ABG were linearly related to preoperative AC, BC, and ABG. Lastly, postoperative ABG-PTA presented differently depending on preoperative stapes superstructure conditions (present: 15.81 ± 11.23 dB, absent: 22.94 ± 12.20 dB, P = 0.009).

CONCLUSIONS

Our study of endoscopic tympanoplasty and tympanomastoidectomy presented complete audiological outcomes for cholesteatoma patients. It had a positive surgery success rate and improved AC, BC, and ABG at every frequency except BC-LF. Additionally, AC-LF and AC-MF improved to a greater degree than AC-HF due to these procedures. Moreover, the linear regression analyses demonstrated that preoperative ABG-PTA was the most efficient audiological indicator for surgery. Likewise, the preoperative condition of the stapes superstructure was proved to be the most efficient anatomical indicator for hearing outcomes.

Ossicular Chain Reconstruction With Titanium Prostheses: A Systematic Review and Meta-Analysis

OBJECTIVES

This review sought to establish expectations for hearing improvement with specifically titanium partial (PORP) and total ossicular replacement prostheses (TORP) to give surgeons an acceptable goal for postoperative hearing results and to counsel patients on their expected results.

DATABASES REVIEWED

MEDLINE/PubMed, EMBASE, and Cochrane Library.

METHODS

A systematic review of the literature was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE/PubMed, EMBASE, Cochrane library) were searched using relevant key search terms to identify studies evaluating outcomes of titanium prostheses. A title/abstract and full article review was then done, and the results from the remaining studies were analyzed with Review Manager 5.4 Software to perform a meta-analysis using a random-effects model.

RESULTS

Forty articles were analyzed after full article review based on the inclusion and exclusion criteria. For PORPs, the average improvement in air-bone gap (ABG) and pure-tone average were 12.1 and 13.5 dB, respectively. For TORPs, the average improvements in ABG and pure-tone average were 16.7 and 17.0 dB, respectively. Preoperatively, the average ABG was 7.0 dB better for PORP than TORP patients, and postoperatively, the ABG improved an average of 4.9 dB more for the PORP cohort. Seventy percent of PORPs and 57% of TORPs subjects had a postoperative ABG less than 20 dB.

CONCLUSIONS

Overall, reconstruction of the ossicular chain with titanium prostheses reliably improves patients' hearing outcomes, and this study gives relevant information for counseling patients preoperatively on realistic hearing outcomes.

Total ossicular chain reconstruction using a titanium prosthesis: functional results

PURPOSE

To evaluate the efficacy and safety of a titanium total prosthesis (TORP) in ossicular chain reconstruction.

METHODS

Retrospective analysis of 113 cases of total ossicular chain reconstruction performed by a single surgeon between 2006 and 2018. Follow-up lasted until January 2020. Participants were patients with chronic otitis media, cholesteatoma, or ossicular chain disruption.

RESULTS

Mean preoperative air-bone gap (± standard deviation) was 32.74 dB (± 11.62). Mean postoperative air-bone gap was 21.68 (± 11.29). Mean air-bone gap improvement was 11.06 dB (± 14.99) (p < 0.001). 57 cases had a post-operative air-bone gap smaller than or equal to 20 dB (50.44%). In four cases, prosthesis dislocation was observed (12.39%). Mean prosthesis length in this group was 5.29 mm (± 0.86) versus 4.36 mm (± 1.02) in cases without prosthesis dislocation (p = 0.002).

CONCLUSIONS

Total ossicular reconstruction using a titanium prosthesis yields favorable functional results, also during prolonged follow-up. Prosthesis length was significantly longer in cases with prosthesis dislocation.

Comparison of Long-Term Microscopic and Endoscopic Audiologic Results After Total Ossicular Replacement Prosthesis Surgery

OBJECTIVE

To compare short-term and long-term outcomes after transcanal endoscope-assisted with microscope-assisted ossiculoplasty using the Fisch titanium total prosthesis (FTTP).

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

PATIENTS

Pediatric (<18 yr of age) and adult patients undergoing ossiculoplasty with the FTTP between January 2016 and December 2019.

INTERVENTION

Transcanal endoscope-assisted (n = 30) or microscope-assisted (n = 76) ossiculoplasty with the FTTP. In the microscopic group, 48 were performed through the ear canal and 28 by retroauricular approach.

MAIN OUTCOME MEASURE

Short-term (3 mo) and long-term (average 20.2 mo) PTA 0.5-2kHz air and bone conduction thresholds were evaluated.

RESULTS

In total, 106 patients were included. Nine of 30 (30.0%) of endoscopic and 15 of 76 (19.7%) of microscopic patients were pediatric. Endoscopic preoperative air conduction PTA 0.5-2kHz was 52.1 ± 15.8 dB and 52.2 ± 17.9 dB for the microscopic group ( p > 0.05). Three months postoperative endoscopic air conduction PTA 0.5-2kHz was 37.6 ± 17.4 dB (14.5 dB improvement) and 44.6 ± 19.9 dB (7.6 dB improvement) in the microscopic group ( p > 0.05). Three months postoperative endoscopic PTA 0.5-2kHz ABG was 26.8 ± 16.6 dB and 28.4 ± 14.7 dB in the microscopic group ( p > 0.05). Latest follow-up endoscopic air conduction PTA 0.5-2kHz audiogram (mean follow-up, 20.6 ± 10.4 mo) was 36.1 ± 18.2 dB (16.0 dB improvement) and 40.1 ± 16.8 dB (12.1 dB improvement) in the microscopic group (mean follow-up, 19.9 ± 10.3 mo)( p > 0.05). For endoscopic air conduction PTA 0.5-2kHz , between the 3 months and latest follow-up audiogram, 25.0% showed improvement, 50.0% remained stable, and 25.0% deteriorated. In the microscopic group, 26.7% improved, 46.6% remained stable, and 26.7% deteriorated ( p > 0.05).

CONCLUSION

Our study shows that hearing results with the Fisch titanium total prosthesis are in line with literature. Endoscope-assisted total ossiculoplasty proves to be a suitable technique with comparable results to the microscopic approach.

Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane

OBJECTIVES

Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps.

METHODS

A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program.

RESULTS

661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20 dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation.

CONCLUSION

The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG threshold, only for PT.

EVIDENCE LEVEL

4.

Audiometric Pattern in Moderate and Severe Tympanic Membrane Retraction

OBJECTIVE

To evaluate the audiometric pattern in moderate/severe retractions of the tympanic membrane and correlate it with the severity of the otoscopy findings.

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary hospital.

PATIENTS

Consecutive patients with moderate or severe tympanic membrane retraction in at least one ear (451 ears) between August 2000 and January 2019, and no surgical history or effusion (mean [standard deviation] age, 32.8 [20.2] yr; 54% female and 42.4% children).

INTERVENTION

Pure-tone audiometry.

MAIN OUTCOME MEASURES

Air conduction (AC) and bone conduction thresholds, and air-bone gap (ABG) measured at the four-frequency pure-tone average.

RESULTS

The median in decibel hearing level (dB HL) (minimum-maximum) of the AC, BC, and ABG were 25 dB HL (0-120 dB HL), 10 dB HL (0-75 dB HL), and 12.5 dB HL (0-55 dB HL), respectively. Seventy-two percent of the ears had an ABG ≤ 20 dB HL. For severity of the retraction of pars flaccida (PF), the AC, bone conduction, and ABG were similar across groups, with a weak correlation. For the pars tensa (PT), there was a global difference in the medians of AC and ABG in terms of the degree of severity, with a moderate correlation. Retraction in PF and PT at the same time was observed in 6 4% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05).

CONCLUSION

The ABG pure-tone average median was higher when PT was involved. We found a significant correlation between the retraction severity and worsening of AC and ABG thresholds, only for PT.

Reliability of high-resolution CT scan in diagnosis of ossicular tympanosclerosis

OBJECTIVES

To evaluate the reliability of high-resolution CT scans (HRCT scans) in the diagnosis of tympanosclerosis and to determine its benefit to predict the post-surgical hearing outcome based on comparing radiological and surgical findings.

METHODS

A retrospective study at a tertiary institute included 940 ears that underwent tyampanoplasty for chronic suppurative otitis media (CSOM) between January 2013 and March 2017. Preoperative temporal bone HRCT scans were analyzed to check for the prediction of tympanosclerosis and ossicular fixation. Intraoperatively, ossicular chain integrity was checked. Preoperative and postoperative audiometric evaluations using air-bone gap (ABG) were compared. A postoperative pure-tone ABG of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups, the study has been reviewed and approved by the IRB at the medical research center in Hamad Medical Corporation; however, it is a retrospective study so no informed consent was obtained from the patients.

RESULTS

The study included 940 ears that underwent tympanoplasties due to CSOM, where 238 out of 940 (25.3%) of ears showed tympanosclerosis during tympanoplasty, intraoperatively, tympanosclerosis was localized to the eardrum in 174 of the 238 involved ears (73.1%), A 64 out of 238 (26.9%) of the ears with tympanosclerosis showed ossicular fixation, divided as 45 ears with Incudo-malleal fixation, 14 ears with stapes fixation, and 5 ears with triple ossicular fixation. HRCT scan of the temporal bone was suggestive of ossicular chain fixation in 79 cases distributed as 55 incudo-malleal fixations, 19 stapes fixation, and 5 complete ossicular fixations, with a sensitivity of 96.8%, and specificity of 98%. The audiological results were analyzed, with a patient follow-up after 6 months.

CONCLUSIONS

Our study showed that CT scans when combined with the clinical findings can be an informative guide to otolaryngologists for preoperative evaluation and counseling of tympanosclerosis surgeries.

Is Ossiculoplasty Necessary in Canal Wall Down Mastoidectomy? Comparison of Clinical Outcomes Between Type 0 Tympanoplasty and Ossiculoplasty

BACKGROUND AND OBJECTIVES

To assess whether the audiological and clinical outcomes of type 0 tympanoplasty (T0) performed using cartilage were comparable with those of ossiculoplasty in patients who underwent canal wall down mastoidectomy (CWDM).

SUBJECTS AND METHODS

This study included patients who had chronic otitis media with cholesteatoma and underwent CWDM with ossiculoplasty involving partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), or T0. Anatomical success rates and hearing outcomes were analyzed.

RESULTS

Seventy-two patients were included in this study; 29 of them underwent CWDM with T0, 27 underwent CWDM with PORP, while 16 underwent CWDM with TORP. The difference in mean improvement in the air-bone gap (ABG) between the groups was not significant. The differences in the rates of ABG closure to ≤10 dB HL (p=0.030) and ≤20 dB HL (p=0.029) were significant. There were significant differences in improvements in the ABG at 3 kHz among the PORP, TORP, and T0 groups.

CONCLUSIONS

The audiological outcomes of CWDM with ossiculoplasty seemed to be better than those of CWDM with T0 with no significant difference in the incidence of complications following ossiculoplasty and T0.

Titanium prostheses versus stapes columella type 3 tympanoplasty: a comparative prospective study

Introduction

Tympanoplasty is a surgical procedure designed to reconstruct the mechanisms of sound transmission in the middle ear.

Objective

Analyze, from an audiological point of view, patients with chronic otitis media undergoing type 3 tympanoplasty major columella with total ossicular replacement titanium prosthesis or with cartilage graft stapes columella.

Methods

This is a prospective analytical study, carried out at the otorhinolaryngology outpatient clinic in a tertiary care hospital, through the evaluation of 26 patients with chronic otitis media who underwent tympanoplasty using different materials for auditory rehabilitation such as titanium prostheses or cartilage autografts.

Results

There was no statistically significant association between the group factors (cartilage or titanium reconstruction) and preoperative variables. There was no statistically significant association between the postoperative characteristics of the patients and the type of reconstruction. Neither subjective improvement (hearing improvement) nor residual perforation were associated with a type of material. The via factor was the only one that showed a statistically significant difference once air-conduction pathway improved more than bone-conduction pathway, decreasing the air-bone gap.

Conclusion

There was no statistical difference between the two groups in relation to the audiometric improvement. There was hearing improvement in both groups. More studies must be done with a longer follow-up to better evaluate the outcome.

Effect of a boomerang-shaped Conchal cartilage graft for Type three Tympanoplasty on Hearing

Introduction  Chronic suppurative otitis media atticoantral disease (CSOM-AAD) is often associated with ossicular erosion resulting in significant hearing loss. Absence of the stapes suprastructure is a poor prognostic indicator of hearing outcome, which necessitates an effective reconstruction technique for ossicular continuity and restoration of middle ear volume. In the present study, we used a boomerang-shaped conchal cartilage graft.

Objective  To evaluate the improvement in hearing using a boomerang-shaped conchal cartilage graft for Type III tympanoplasty in cases of CSOM-AAD in which the stapes suprastructure was absent and to study the incidence of intraoperative/postoperative complications of this procedure.

Method  A total of 21 patients with CSOM-AAD who were found to have absent stapes suprastructure intraoperatively were included. A boomerang-shaped conchal cartilage graft was placed over the stapes footplate for reconstruction following canal wall down mastoidectomy. Pure tone audiogram (500, 1,000, 2,000 and 4,000 Hz) was done preoperatively and at 12 weeks postoperatively. Hearing outcome and incidence of complications were noted.

Results  There was a statistically significant reduction in the hearing loss for air conduction and air-bone gap (ABG) of 6.1 dB and 6.9 dB respectively ( p  < 0.05). Air-bone gap < 30 dB could be achieved in 71.4% of the patients as compared with 23.8% preoperatively. No significant difference was noted in the bone conduction threshold (p > 0.05). A better hearing outcome was observed at higher frequencies (2,000, 4,000 Hz). No major complications were encountered.

Conclusion  A boomerang-shaped conchal cartilage graft is effective when used for Type III tympanoplasty, especially at higher (2,000, 4,000 Hz) frequencies, and is comparable to newer materials such as titanium total ossicular reconstruction prosthesis (TORP). No major intraoperative/postoperative complications were noted.

Evaluation of Type III Tympanoplasty Using Cartilage Ossiculoplasty in Cholesteatoma Ear Surgery

This prospective observational study evaluates the role of tympanoplasty type III in cholesteatoma ear disease during same sitting with mastoid surgery using cartilage ossiculoplasty. Forty patients of chronic suppurative otitis media-cholesteatoma disease were recruited in the study. All the patients had extensive cholesteatoma and underwent canal wall down mastoid surgery. Tympanoplasty type III, that is, stapes columella, minor columella, or major columella, was done in each case along with mastoid surgery depending upon the remnant ossicular status. Conchal cartilage graft was used for ossiculoplasty along with temporalis fascia graft. Hearing and graft uptake results were evaluated at the end of 6 months postoperatively. Of the 40 cases, 3 cases failed tympanoplasty. In the remaining 37 cases, a statistically significant hearing improvement (air-bone gap of 33 dB) was observed postoperatively. Seven cases underwent stapes columella, 13 cases underwent minor columella, and 17 cases underwent major columella tympanoplasty type III. Although a hearing improvement was recorded in all these subgroups, a statistically significant hearing gain was present only in tympanoplasty type III minor columella cases thereby underlying the importance of intact stapes. However, it is difficult to discern the type of tympanoplasty type III that the patient would undergo prior to the ear surgery.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

Objective

(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.

Study Design

Case series with chart review.

Setting

Tertiary care center.

Subject and Methods

This study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.

Results

In total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).

Conclusion

Titanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

The benefit of trans-attic endoscopic control of ossicular prosthesis after cholesteatoma surgery

OBJECTIVE

To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma. TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis.

METHODS

A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall-up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure-tone average air-bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups.

RESULTS

Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP).

CONCLUSION

Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery.

LEVEL OF EVIDENCE

4 Laryngoscope, 129:2754-2759, 2019.

Tympanoplasty - news and new perspectives

Techniques and biomaterials for reconstructive middle ear surgery are continuously and steadily developing. At the same time, clinical post-surgery results are evaluated to determine success or failure of the therapy. Routine quality assessment and assurance is of growing importance in the medical field, and therefore also in middle ear surgery. The exact definition and acquisition of outcome parameters is essential for both a comprehensive and detailed quality assurance. These parameters are not the audiological results alone, but also additional individual parameters, which influence the postoperative outcome after tympanoplasty. Selection of patients and the preoperative clinical situation, the extent of the ossicular chain destruction, the chosen reconstruction technique and material, the audiometric frequency selection and the observational interval are only some of them. If these parameters are not well documented, the value of comparative analyses between different studies is very limited. The present overview aims at describing, comparing, and evaluating some of the existing assessment and scoring systems for middle ear surgery. Additionally, new methods for an intraoperative quality assessment in ossiculoplasty and the postoperative evaluation of suboptimal hearing results with imaging techniques are available. In the area of implant development, functional elements were integrated in prostheses to enable not only good sound transmission but also compensation of occurring atmospheric pressure changes. In combination with other components for ossicular repair, they can be used in a modular manner, which so far show experimentally and clinically promising results.

Titanium incus interposition ossiculoplasty: audiological outcomes and extrusion rates

This study aimed to evaluate the benefit but also the extrusions, dislocations, and failures of a titanium incus prosthesis along with the long-term audiological outcomes. We prospectively collected data from 139 patients undergoing ossiculoplasty using the Fisch titanium incus prosthesis between 2001 and 2016. Overall, 126 patients with at least 6 months of follow-up (mean 4.5 years, range 6-155 months) were analyzed. Patients were grouped as "extrusion" (n = 9, 7%) if the prosthesis extruded, "failure" (n = 22, 18%) if a reoperation was needed concerning the prosthesis, and "stable" (n = 95, 75%) if the prosthesis remained functional in the middle ear. Mean postoperative air bone gaps (ABG) for 0.5-3 kHz for the overall group and the stable group were 19.8 (±11.9) and 15.3 (±7.5), respectively. Long-term results of stable group revealed an ABG (0.5-3 kHz) below 10 dB in 25% and below 20 dB in 81% of the patients. Atelectasis was the most frequent cause of extrusion, which occurred after a mean time of 28.7 months (range 15-48 months). Mean timing for reoperation was 30.7 months (range 5-131 months) in the failure group. There was no significant difference in mean postoperative ABG among patients with or without cholesteatoma, primary or staged ossiculoplasty in cholesteatoma, presence or absence of malleus head at the time of ossiculoplasty, open or closed cavity surgeries, or the degree of pneumatization of the temporal bone. The Fisch titanium incus prosthesis is a reliable alternative to using autologous incus for interposition ossiculoplasty, with similar hearing outcomes. Using this prosthesis, a 15 dB ABG should be expected.

Data and Reporting Quality in Tympanoplasty and Ossiculoplasty Studies

Objective

The objective of our study was to check the documentation of hearing outcome parameters and influencing factors (surgical, pathological, and methodological) in published literature evaluating hearing outcome after tympanoplasty. We aimed to assess how effectively the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) 1995 guidelines were applied.

Study Design

Retrospective noncontrolled study.

Setting

Ear research center.

Subjects and Methods

This study was based on a PubMed research, including peer-reviewed English-speaking original studies published from January 2005 to December 2015. In total, 169 studies were checked for correct description of study population, surgical methodology, study design, and documentation of the hearing outcome. In addition, the correct application of AAO-HNS 1995 criteria was checked.

Results

Pre- and postoperative air-bone gap were shown as mean ± standard deviation in half of all series (52% vs 56%). The recommended frequency spectrum (0.5-3 kHz) was used in 46%, while a documentation of frequency spectrum was available in 85%. Whereas a statement on presence of stapes suprastructure (81%) and initial pathology was usually available, mucosa status (17%) and aeration (8%) were only shown in few series. Revision cases, staged cases, and myringoplasty graft material were documented in 46% to 57%. Type and material of prosthesis were represented in 74% to 82%. None of the publications analyzed fulfilled all 10 AAO-HNS criteria. In 10%, 7 to 9 criteria were used correctly.

Conclusion

A heterogeneous description of surgical and pathological findings and the application of minimal reporting standards are essential preconditions to enable comparisons between different studies and to generate meta-analysis.

Titanium Ossicular Chain Reconstruction Revision Success and Preoperative Factors Predicting Success

Objective Determine rates of success after revision titanium ossicular chain reconstruction with either partial or total ossicular replacement prosthesis and assess preoperative factors predicting positive outcomes. Study Design Case series with planned data collection. Setting Tertiary hospital. Subjects and Methods The charts of 76 surgical patients who underwent revision titanium ossicular chain reconstruction from 2003 to 2014 were abstracted from a prospectively maintained database at the Medical University of South Carolina. Postoperative air-bone gap (ABG) after revision surgery at short-term (<6 months) and intermediate to long-term (>1 year) follow-up and preoperative factors associated with postoperative ABG ≤20 dB were recorded. A paired t test or Wilcoxon signed-rank sum test was utilized to compare preoperative, short-term, or intermediate to long-term results. Results Seventy-six patients underwent revision ossiculoplasty and met inclusion criteria. Mean postoperative ABG was 22.5 at short-term follow-up ( P < .0001) and 24.4 at intermediate to long-term follow-up ( P = .003). Postoperative ABG ≤20 dB was achieved in 51.5% of patients. The only preoperative factor associated with postoperative ABG ≤20 dB was location of original primary ossiculoplasty ( P = .01). Conclusions This is one of the larger studies involving revision titanium ossiculoplasty. Revision surgery showed a significant improvement in postoperative ABG. The location of the original ossiculoplasty correlated with success of revision surgery (defined as postoperative ABG ≤20 dB). Patients who had the primary ossiculoplasty at an outside hospital may have better audiometric outcomes than patients who had it at a tertiary hospital.

Autologous incus versus titanium partial ossicular replacement prosthesis in reconstruction of Austin type A ossicular defects: a prospective randomised clinical trial

OBJECTIVE

This study aimed to compare the functional and anatomical outcomes of ossiculoplasty using an autograft incus or a titanium partial ossicular replacement prosthesis for reconstructing Austin type A ossicular defects.

METHODS

Patients with Austin A ossicular defects were randomly divided into two groups: one group underwent ossiculoplasty with an autologous incus (the autologous incus group) and the other underwent ossiculoplasty with a titanium partial ossicular replacement prosthesis (the titanium prosthesis group). Otoscopic examination and audiological assessment was done pre-operatively and at 3, 6 and 12 months post-operatively.

RESULTS

A post-operative average air-bone gap closure of less than 20 dB was seen in 13 patients (65 per cent) in the autologous incus group and 7 (35 per cent) in the titanium prosthesis group. There were fewer post-operative complications in the autologous incus group (20 per cent) than in the titanium prosthesis group (45 per cent).

CONCLUSION

Hearing outcomes and graft take up after ossiculoplasty were significantly better when an autologous incus rather than a titanium partial ossicular replacement prosthesis was used to reconstruct Austin type A ossicular defects. The major disadvantages of the titanium prosthesis were unpredictable results and more post-operative complications.

Preoperative Predictors in Chronic Suppurative Otitis Media for Ossicular Chain Discontinuity: A Cross-Sectional Study

OBJECTIVE

Ossicular discontinuity may result from chronic suppurative otitis media and is usually detected intraoperatively. Our objective is to determine whether a preoperative audiogram can preoperatively predict the presence or absence of ossicular discontinuity.

METHODS

A cross-sectional study was prospectively run on our patients, aged 12-75 years, ultimately operated on for chronic suppurative otitis media. Preoperative audiograms were analyzed to measure frequency-specific air-bone gap (ABG) cutoff values. Intraoperatively, ossicular chain integrity was carefully checked. Logistic regression analysis was done to obtain a predictive model.

RESULTS

A total of 270 patients (306 ears) were included. Frequency-specific ABG cutoff values can predict ossicular discontinuity, namely: high ABGs at 1,000 Hz (>27.5 dB) and 2,000 Hz (>17.5 dB) are the most reliable variables associated with ossicular discontinuity.

CONCLUSION

Preoperative audiograms can predict the presence of ossicular discontinuity in chronic suppurative otitis media. Large ABGs at both 1,000 and 2,000 Hz can predict ossicular discontinuity with a great degree of certainty.

Long-term Outcomes of Titanium Ossiculoplasty in Chronic Otitis Media

Objective

The primary objective is to report long-term hearing outcomes (>2 years) after titanium ossiculoplasty in patients with chronic otitis media.

Study Design

Case series with chart review.

Setting

Tertiary care hospital.

Subjects and Methods

In total, 156 patients with chronic otitis media undergoing titanium ossiculoplasty were included. The primary outcome measure was the long-term postoperative ABG. The stability of hearing over time was determined by comparing short-term and long-term postoperative air-bone gap (ABG). Secondary outcome measures included ΔABG, postoperative speech reception thresholds, air-conduction pure-tone average (AC PTA), word recognition scores, and percentage of patients achieving ABG ≤20 dB. Revision and extrusion rates were examined.

Results

At short-term follow-up (<6 months), mean postoperative ABG was 18.4 ± 10.6 dB and AC PTA was 31.7 ± 15.2 dB; 67% of patients achieved ABG ≤20 dB. At long-term follow-up (>2 years), mean ABG was 20.0 dB ± 15.4 and AC PTA was 35.3 ± 16.1 dB; 60% of patients achieved ABG ≤20. At both short- and long-term follow-up, ABG and AC PTA were significantly improved compared with preoperative values. No difference in hearing outcomes was observed when comparing partial titanium ossicular prostheses (PORPs) to total titanium ossicular prostheses (TORPs) at either short- or long-term follow-ups. In patients with both short- and long-term follow-up (n = 50), deterioration in hearing was noted (3.4 dB, P = .04). When analyzed by type of prosthesis, PORPs demonstrated statistically significant deterioration in ABG over time (4.9 dB, P = .02), while TORPs did not (2.5 dB, P = .50). The long-term extrusion rate was 3.2%.

Conclusion

With a minimum follow-up of 2 years, titanium ossiculoplasty provides good long-term hearing results. Modest deterioration in hearing is noted over time.

Cartilage ossiculoplasty in cholesteatoma surgery: hearing results and prognostic factors

Cartilage tympanoplasty is an established procedure for tympanic membrane and attic reconstruction. Cartilage has been used as an ossiculoplasty material for many years. The aim of this study was to evaluate hearing results of costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for middle ear cholesteatoma and to determine the presence of prognostic factors. Candidates for this study were patients affected by middle ear cholesteatoma whose ossicular chain was reconstructed with a chondroprosthesis. 67 cases of ossiculoplasty with total (TORP) or partial (PORP) chondroprosthesis were performed between January 2011 and December 2013. Follow-up examination included micro-otoscopy and pure tone audiometry. The guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology Head and Neck Surgery were followed and pure-tone average (PTA) was calculated as the mean of 0.5, 1, 2 and 4 kHz thresholds. Statistical analysis was performed with ANOVA tests and regression models. Average air-bone gap (ABG) significantly improved from 39.2 dB HL (SD 9.1 dB HL) to 25.4 dB HL (SD 11 dB HL) (p < 0.001). Linear regression analysis showed that the only prognostic factor was the type of operation (p = 0.02). In fact, patients submitted to ICWT presented better post-operative ABG compared to CWDT. None of the other variables influenced the results. The present study proposes costal cartilage as material of choice when autologous ossicles are not available. The maintenance of the posterior canal wall was the only prognostic factor identified.

Titanium prosthesis or autologous incus for total ossicular reconstruction in the absence of the stapes suprastructure and presence of mobile footplate

The purpose of this study was to compare the hearing results after total ossicular replacement with a titanium prosthesis or autologous incus in the absence of stapes suprastructure and presence of mobile footplate as a retrospective medical record review in a tertiary referral center setting. There were 49 patients who had total ossicular reconstruction (titanium prosthesis, 40 patients; autologous incus, 9 patients). Medical records were reviewed after total ossicular replacement. Air-bone gap at 1 and 2 years after surgery were determined with the 4-frequency average (0.5, 1, 2, and 4 kHz) and the American Academy of Otolaryngology-Head and Neck Surgery 4-frequency average (0.5, 1, 2, and 3 kHz). The number of patients who had air-bone gap <20 dB was determined. For comparisons that were based on American Academy of Otolaryngology-Head and Neck Surgery 4-frequency average, mean air-bone gap at 2 years after surgery was significantly smaller for the titanium prosthesis (21 dB) than autologous incus group (31 dB; P ≤ 0.03); the frequency of patients who had air-bone gap <20 dB at 1 or 2 years after surgery was significantly greater for the titanium prosthesis (1 year, 40%; 2 years, 56%) than autologous incus group [1 year, 0% (P ≤ 0.03); 2 years, 0% (P ≤ 0.04)]. Titanium prosthesis ossiculoplasty gave better results than autologous incus in the absence of the stapes suprastructure and presence of a mobile footplate.

Audiometric Outcome Comparison between Titanium Prosthesis and Molded Autologous Material

Objective

To evaluate and compare the audiometric outcomes of ossicular reconstruction with titanium prosthesis and autologous material.

Study Design

Retrospective cohort study.

Setting

Tertiary referral center.

Subjects and Methods

Audiometric results of consecutive patients who performed ossiculoplasty with titanium prosthesis (n = 43) or autologous material (n = 48), from October 2008 to December 2011, were reviewed retrospectively and compared. The association between air-bone gain and age, ossiculoplasty material (autologous or titanium), preoperative diagnosis (chronic otitis media without cholesteatoma, cholesteatoma, or conductive hearing loss with intact tympanic membrane), and type of surgery (tympanoplasty, canal wall-down mastoidectomy, or canal wall-up mastoidectomy) was explored using regression analysis.

Results

Preoperative audiometric evaluation did not show differences between titanium and autologous groups in air-bone gap and pure-tone average. A postoperative decrease of 11.0 dB in air-bone gap and 12.4 dB in pure-tone average was observed in titanium ossiculoplasty compared with a reduction of 4.0 dB in air-bone gap and 5.1 dB in pure-tone average when autologous reconstruction was used. Mann-Whitney test revealed superior results in the titanium group compared with autologous reconstruction patients in air-bone gap ( P = .02) and pure-tone average ( P = .02). However, no statistically significant associations were observed after multivariate linear regression analysis of air-bone gap gain when adjusted for age, ossiculoplasty material, type of surgery, and preoperative diagnosis. One titanium prosthesis extrusion occurred during follow-up (2%).

Conclusion

Audiometric results achieved by titanium prosthesis are promising, but significant differences compared with autologous ossiculoplasty were not present.

Comparison of hearing results of malleovestibulopexy and total ossicular replacement prosthesis for chronic otitis media patients with a mobile stapes footplate

OBJECTIVE

This study aimed to assess differences in hearing outcomes using the malleostapedotomy or malleovestibulopexy (MVP) and total ossicular replacement prosthesis (TORP) techniques in chronic otitis media patients with a mobile stapes footplate.

STUDY DESIGN

Case series with planned data collection.

SETTING

A university medical center.

SUBJECTS AND METHODS

In total, 27 patients with chronic otitis media at the Sixth Hospital affiliated with Shanghai Jiao Tong University, between January and October 2010, were included. All patients had destruction of incus and stapes superstructures and a mobile stapes footplate. In all patients, surgery was performed under general anesthesia by a retroauricular approach. After the lesions were removed completely, ossicular reconstruction was performed using 1 of the techniques. In all patients, pure-tone audiograms were assessed before and 12 months after surgery.

RESULTS

Thirteen patients underwent MVP surgery, whereas the other 14 cases received traditional TORP surgery. All patients showed improvements in functional hearing after surgery. Although the numbers of ears that had closure of the air-bone gap within 20 dB in the MVP group were not statistically significantly higher than those in the TORP group (Fisher's exact test, P > .05), the average postoperative gain of the MVP group was significantly higher than that of the TORP group (t test, P < .05).

CONCLUSION

Functional hearing in chronic otitis media patients with a mobile stapes footplate was better in those who underwent MVP surgery than in those who underwent TORP surgery.

Middle ear surgery in Thuringia, Germany: a population-based regional study on epidemiology and outcome

OBJECTIVE

To evaluate population-based data on incidence and efficiency of middle ear surgery.

STUDY DESIGN

Retrospective review.

SETTING

All otolaryngology departments in one federal state in Germany.

PATIENTS

All 1,037 middle ear surgeries performed in Thuringia in 2005.

INTERVENTIONS

Middle ear surgery.

MAIN OUTCOME MEASURE

Analysis of preoperative and postoperative audiometric results, preoperative diagnostics, and postoperative complications. Univariate statistical tests were used to analyze predictors for air-bone gap (ABG) improvement, complications, and need for resurgery. Population data were used to calculate incidences of middle ear diseases admitted for surgery and annual rates of middle ear surgeries.

RESULTS

ABG improved after surgery for chronic otitis media without and with cholesteatoma, otosclerosis, trauma cases, or complication after acute otitis media/externa (p < 0.0001; p < 0.0001; p < 0.0001; p = 0.005; p = 0.004; respectively). Middle ear surgery significantly improved bone conduction in cases of otosclerosis (p = 0.008), sudden deafness (p = 0.006), and acute otitis media/externa with complication (p = 0.004). There was a trend of more complication in patients older than 60 years (p = 0.055). Surgery was indicated for chronic otitis media without cholesteatoma in 17.4/100,000 persons, for cholesteatoma in 15.0/100,000, for otosclerosis in 5.7/100,000, for sudden deafness with suspicion of perilymph fistula in 1.5/100,000, and for trauma with affection of the lateral cranial base and hearing loss or otitis media with complication in 1.3/100,000 habitants, respectively. A cochlear implant was indicated in 1.0/100,000 habitants.

CONCLUSION

This population based analysis is showing that middle ear surgery is performed country-wide with good results and low risk on important scale in daily routine by ear surgeons.

Short- and long-term results of ossicular reconstruction using partial and total plastipore prostheses

OBJECTIVE

To evaluate the short- and long-term success of using a plastipore prosthesis for partial and total ossiculoplasty (POP and TOP). Subtechniques for optimal hearing improvement are discussed. Literature review and comparison to the recent use of titanium prostheses is made.

STUDY DESIGN

Retrospective review of partial and total ossiculoplasties.

SETTING

Private practice tertiary otologic center.

PATIENTS

A total of 152 patients who underwent ossicular reconstruction by the primary author greater than 3 years before this investigation with long-term results (mean, 4.3 yr) available for 83 patients.

MAIN OUTCOME MEASURES

Preoperative and postoperative air and bone conduction thresholds and air-bone gap for pure tone averages for 4 frequencies. Percentage of patients achieving an air-bone gap (ABG) of less than or equal to 10 dB abd 20 dB.

RESULTS

The percentage of patients closing their ABG to within 10 dB was 51.3% and 75% to within 20 dB short term. The mean PTA ABG for the POP patients was 11.9 and 15.8 dB for the TOP groups short term. For the long-term group, 41.7% of POP patients had 10 dB or lower ABG and 81.2% within 20 dB. In the TOP group, 20% had a PTA ABG of 10 dB or lower with 60% within 20 dB ABG long term. There were no patients with complication of significant sensorineural hearing loss. One extrusion occurred in this group of patients.

CONCLUSION

Functional results with the POP and TOP plastipore prostheses were good postoperatively. Longer-term results also supported the use of these prostheses and techniques in that more than 53 months, our partial ossiculoplasty cases had a minimal air-bone gap worsening of only 1.7 dB. The total ossiculoplasty cases had a 6.3 dB air-bone gap decline, which is less than a 1.5 dB decrease per year.

Quality of Life After Cholesteatoma Surgery

Objectives:

The aim of this study was to evaluate, by means of the Chronic Ear Survey (CES), the quality of life of patients who had undergone either intact–canal wall tympanoplasty (ICWT) or canal wall–down tympanoplasty (CWDT) with mastoid obliteration.

Methods:

This was a retrospective case review study performed at a tertiary referral center. Among 379 patients affected by middle ear and mastoid cholesteatoma operated on between November 2000 and December 2009, 50 patients who underwent ICWT and 50 who underwent CWDT with mastoid obliteration were randomly selected. The CES scores were analyzed for both groups.

Results:

The mean scores on the CES were 6.5 ± 2.1 in patients who underwent CWDT and 6.9 ± 2.2 in patients treated with ICWT ( t = −0.93; p > 0.05). No significant differences between the two groups were found on the activity restriction, symptom, or medical resource subscales (p > 0.05).

Conclusions:

The results of this study demonstrate that CWDT with mastoid obliteration resulted in a quality of life comparable with that after ICWT. Postoperative hearing loss is the most frequently reported problem for both techniques.

Is it the middle ear disease or the reconstruction material that determines the functional outcome in ossicular chain reconstruction?

OBJECTIVES

To evaluate the effects and the predictive value of environmental risk factors on the success of different reconstruction materials used in ossiculoplasty.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral university hospital.

PATIENTS

Between January 2007 and October 2010, 110 patients who underwent ossiculoplasty with or without mastoidectomy due to chronic otitis media were enrolled in the study. All patients were classified into 1 of the 3 risk groups (mild, moderate, and severe) according to their measured Middle Ear Risk Index score.

INTERVENTIONS

The patients underwent exploratory tympanotomy, tympanoplasty, or tympanomastoidectomy (canal wall-up or wall-down), all with ossicular reconstruction. The ossicular reconstructions were performed using either bone cement, autologous bone interposition, or allograft material.

MAIN OUTCOME MEASURES

For each patient, the air-conduction threshold and air-bone gap (ABG) were measured at the 12th month after ossiculoplasty. The ABG gain and air-conduction improvement were compared with preoperative values. The correlation of the success of ossiculoplasty with the middle ear risk group of patients was investigated. Moreover, the efficacy of different types of reconstruction material on the success of ossiculoplasty in the same risk group was evaluated.

RESULTS

In the mild- and moderate-risk groups, the ABG gain (p = 0.001 and p = 0.014) and air-conduction improvement (p < 0.001 for both) were statistically significant, whereas those changes were found to be insignificant in the severe-risk group. Moreover, the ABG gain and air-conduction improvement in none of the risk groups revealed a significance in favor of any of the used reconstruction materials.

CONCLUSION

The results of this study revealed that none of the reconstruction materials or specific techniques have a superiority in the functional outcomes in patients from the same middle ear risk group. We conclude that the success of ossiculoplasty is highly correlated with the pathophysiological status of the middle ear and is independent of the type of replacement material.

Middle ear implants: functional gain in mixed hearing loss

Osseous atresia and chronic otitis media are diseases benefit with middle ear implants. Surgery for atresia is technically complicated, has significant number of complications and functional results are often poor. The osseointegrated hearing aids are an alternative. They provide a very good functional gain, but have many problems with the skin and osseointegration. In chronic otitis media, the ossiculoplasty solved partially the hearing problem. Unfortunately in some cases of otitis media and in open cavities fitted with conventional hearing aids the gain is unsatisfactory.

Aim

To determine the usefulness of an active middle ear implant.

Material and method

Longitudinal Study. Vibrant-Soundbrigde was implanted in 8 patients with severe mixed hearing loss. 4 patients had chronic otitis media and 4 had unilateral atresia. The placement of the stimulator (FMT or Floating Mass Transducer) was in 5 patients on round window, 2 in stapes and one in the oval window.

Results

Functional gain was 35 dB, 40 dB, 48.7 dB and 50 dB for the frequencies 500, 1000, 2000 and 4000 Hz, respectively.

Conclusion

Vibrant-Soundbrigde is an excellent option in hearing recovery in severe and profound mixed hearing loss. It also provides an excellent functional gain in diseases difficult to treat with conventional hearing aids.

Ossiculoplasty with total ossicular replacement prosthesis and Omega Connector: early clinical results and functional measurements

OBJECTIVE

Among other difficulties, achieving a stable position of a total ossicular replacement prosthesis (TORP) is demanding because of a limited view on the TORP-footplate interface and individual angles between the footplate and tympanic membrane. The Kurz Omega Connector aims at a simplified insertion of the TORP. The performance of total ossicular reconstruction using the Omega Connector was evaluated.

STUDY DESIGN

Prospective cohort study and experimental measurements with a fresh human temporal bone.

SETTING

Tertiary referral center.

PATIENTS

Seventeen consecutive patients receiving total ossicular reconstruction were included. Historical control group composed of 36 patients.

INTERVENTIONS

Total ossicular reconstruction using the Omega Connector.

MAIN OUTCOME MEASURES

(a) Handling of the TORP and Omega Connector intraoperatively, (b) functional short-term results compared with a historical control group, (c) sound transmission properties with 3 different connective positions between the TORP and the Omega Connector.

RESULTS

Placing the Omega Connector on the footplate and coupling the Omega Connector to the TORP was straightforward in 65% of cases. A stable final position of the TORP was obtained in 88% of cases. Mean (SD) preoperative and postoperative air-bone gaps were 36.00 (11.05) and 25.29 (12.25) dB and were almost identical with those in the historical control group (p = 0.9). In the experimental measurements, functional outcomes with "partial connection" showed almost the same results as those with "full connection."

CONCLUSION

The Omega Connector provides easy handling of the TORP. The short-term functional results were comparable to those achieved previously without the Omega Connector. The temporal bone measurement supports tolerance in connective position between the TORP and the Omega Connector.

[Microsurgical middle ear operations : Variability of the audiometric results from frequency variations]

INTRODUCTION

The audiometric results after reconstructive tympanic surgery on 504 patients carried out between October 2005 and October 2007, including 190 cases of tympanoplasty type I and 314 cases of tympanoplasty type III according to Wullstein, were retrospectively analyzed at the Department of Otolaryngology, Ruprecht-Karls-University in Heidelberg.

PATIENTS AND METHODS

To investigate the influence of the frequencies used to compare the outcome, the pure tone average air-bone gaps (PTA-ABG) of the preoperative and postoperative audiograms of tympanoplasties type I and III were analyzed. The frequencies covered the ranges of 0.5 kHz, 1 kHz, 2 kHz, 4 kHz and 6 kHz. In each case the 3-frequency, 4-frequency and 5-frequency analyses were calculated for the different surgical groups.

RESULTS

The 3-frequency analysis (0.5 kHz, 1 kHz and 2 kHz) of the type 1tympanoplasties were 18.8 ± 11.8 dB preoperative and 12.3 ± 11.8 dB postoperative. In 58.9% of cases the PTA-ABG ≤ 10 dB and in 86.7% it was ≤ 20 dB. The 3-frequency analysis showed that the tympanoplasties type III had a PTA-ABG of 30.6 ± 15.3 dB preoperatively and 21.8 ± 15.1 dB postoperatively. In 30.4% of cases the PTA-ABG was ≤ 10 dB and ≤ 20 dB for 56%.

DISCUSSION

The detailed itemization of frequencies in this study and the consequent opportunity to modify the frequency range, allowed the impact of this selection on the PTA-ABG to be illustrated and various comparisons with other studies could be carried out. In this article, the exclusion criteria were dealt with liberally and risk patients were also included and data from patients who displayed prognostic risks regarding the successful surgery in terms of the audiometric reports were integrated. These prognostic risks were due to the poor aeration of the tympanum and recent (sometimes diverse), pre-surgery as well as chronic inflammatory processes. This study has proved that all surgery collectives showed significant improvements of the PTA-ABG. Therefore, all surgery collectives (measured against the audiometric evaluation) benefited from the surgery.